A sarcastic veterinary blog dedicated to all of the money grubbing vets out there who are fed up with the insanity of the American public.

Monday, April 23, 2012

When Our Own Pets Get Sick

Because most vets own pets, and most pets get sick from time to time, it stands to reason that at some point we are going to have to deal with illness in our own pets. One would think that with our vast medical knowledge, deep understanding of the pathophysiology behind the illness, and our analytic minds, dealing with illness in our pets would be easy. One would be wrong. When our pets are sick, really sick, we have the same feelings of fear, anxiety, and helplessness that a layperson has.

Several years ago, my own dog became acutely and critically ill with two conditions called Immune Mediated Thrombocytopenia and Immune Mediated Hemolytic Anemia. These are life threatening conditions in which the body attacks its own platelets (blood cells essential for clotting) and oxygen carrying red blood cells. These conditions are fairly common in dogs. Sometimes there is an underlying cause such as infection, cancer, or recent vaccination. Most of the time however, the cause in unknown.

I first noticed that my old girl was sick because when she rolled over for a belly rub late one evening, there were 2 small areas of bruising on her skin. She had not had an injury, and there was no reason she should have been bruised. I did a physical exam on her, and noticed there was some bleeding around her gums too. I was immediately struck by a sense of dread, because I knew what the likely cause was. Sure enough, when I ran her lab work, her platelet count was 9,000 (normal is 150,000-300,000). With a platelet count that low, she was at risk for nosebleeds, or hemorrhaging into her chest, bladder, intestines, or joints. In short, I knew she could die. I knew that the smallest injury such as cutting her foot on a piece of glass while walking, or a cut on her gum from chewing a stick could be fatal. Worst of all, I had no idea what caused it. Was there a horrible cancer somewhere inside her? A serious infection? I submitted a complete series of lab tests, and started her on antibiotics. In my dog's case, I never found an underlying cause. The mainstay of treatment for this condition (regardless of cause) involves suppressing the immune system so it will stop attacking her. She was placed on a high doses of the immune suppressing drugs prednisone and azathiaprine. I knew these drugs could save her life, but I also knew they had potential for serious side effects (bladder infections, increased thirst and urination, panting, stomach ulcers, and liver failure).

The medications take time to work, and she initially got worse. She refused to eat, she was weak, she developed severe bruising over her entire chest and abdomen, and edema (swelling) of the skin. One evening, she began having heavy breathing and her gums became pale. I drove her to the local emergency clinic at 2am, crying because I knew all the horrible things that could be happening to her (fatal internal bleeding, severe anemia, perforated stomach ulcer). It turned out that her red blood cells (which initially were normal) had been attacked by her body too. She was anemic. Her anemia was not quite severe enough to require transfusion, but it meant that additional immune suppressing drugs had to be added, and close monitoring was needed.

She did eventually fully recover, but the experience helped me realize how truly frightening a critically ill pet is for clients. I thought I understood before, and I have always been sympathetic, but this experience gave me empathy. Watching her refuse to eat meal after meal, wondering if she was going to have a fatal hemorrhage (I honestly wanted to wrap the poor dog in bubble wrap and set her on a shelf to protect her from any possible trauma that could set off bleeding). I also gained a true understanding of the impact that the side effects of the medications can have on the owner's life. The most common side effect of prednisone is increased thirst and urination. I always warn clients about that. It is a well known fact, and is listed in every drug book I own. Reading about it and living with it are two different things. My dog was 100% house trained, and I am fortunate to live close enough to work that I am able to make it home for lunch on most days. This meant that she was alone for only 5 hours between bathroom breaks. This is perfectly manageable for a healthy dog. For a sick dog on prednisone, it is not. I came home day after day to an empty water bowl, and large puddles of urine. I had to use baby gates to keep her in the kitchen/dining area (where there was vinyl instead of carpet). She was used to sleeping on the sofa, and I felt like a horrible person for shutting her out of the comfort of the carpeted living room and cushy sofa. I packed towels along the threshold of the vinyl and carpet to soak up her accidents. I did at least one full load of laundry every day from those urine soaked towels. More than once, I had to move appliances when her puddles ran under them. I soon learned to pack towels around those too. Try as I might, at the end of a long day, when I came home to a mess, I could not hide my frustration. Of course, I didn't yell at my dog or punish her, but dogs are very in tune to our body language. She didn't understand why, but she knew that instead of just being really happy to see her, I looked stressed and frustrated. That made her feel confused and anxious, and I felt like an even more horrible person. Fortunately, as she improved, I was able to taper the medication, and the side effects diminished. Although relapse is common in these conditions, she never had another episode, and she died of unrelated causes 3 years later. Though I hated going through this experience, I appreciate what I learned from it, and it has helped me better relate to clients who have pets with this condition.

6 comments:

My own Golden Retriever had AIHA too but she needed transfusions and I can relate to your issues nursing her - helpless and frustrated. She lived on a large washable mat in the bathroom for ages and it was miserable... the other side effect was the muscle wasting and the weakness meant she couldn't walk anyway. We carried her a lot. Later, she had such a voracious appetite she ate a wheat bag - huge amount of fermented wheat passed through. Gross...

She recovered - same drug regime - some years later she bit our granddaughter in the face and we sadly put her to sleep - whatever the reason, and there was no obvious illness or pain, her time was up.Our beautiful golden girl.

I have just recently had to experience the trials of treating my own pet for a serious illness. My 1 & 1/2 yr old male neutered tuxedo rescue developed a urethral obstruction.

I am so thankful I went home for lunch and noticed that he wasn't his usual chipper self. He has some rear leg problems due to the acute trauma that landed him in the ER and a permanent member of my furry clan to begin with. I noticed that his rear limb function was acutely worse and my physical exam revealed a firm bladder the size of an orange. I choked back the nausea and fear and rushed him to work and unblocked him and started him on the typical urethral obstruction regime. I also had to face the fact that he had obvious stones on radiographs and would need a cystotomy as well. Again, I choked back the nausea and performed the surgery on my own furry kid and thing went well.

What I didn't realize is just what it takes out of you, physically and emotionally when you take your pet home for "after care". Checking the bladder and litter box every few hours, cleaning up after the constant urine dribble, praying to see productive pee in the box, forcing down at least a half a dozen meds down a cat every 12 hours.Needless to say, even though I see this condition on a weekly basis being an ER doc, I never truly got how scary and frustrating it can be AFTER the drama of getting them unblocked. I don't know if I can be rational the next time Momma has to be doctor.

My cat has hypertrophic cardiomyopathy and feline lower urinary tract disease. When my clients try to apologize for crying or otherwise being upset that their animals are sick, I tell them the truth: I know what to do when my cat is ill because I'm his vet, but I *still* turn into a complete basketcase.

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